Bipartisan mental health bill advances in Senate

The Senate Health Committee on Wednesday advanced a bipartisan mental health bill to the full Senate as part of a difficult push to achieve mental health reform in an election year. 

{mosads}The bill, a narrow consensus document, passed the committee unanimously on a voice vote. More thorny issues are expected to be dealt with later on the Senate floor.

Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) said the underlying bill is ready to be considered whenever Senate Majority Leader Mitch McConnell (R-Ky.) chooses. 

“Many of us, on both sides of the political aisle, believe there is a mental health crisis, and that’s why so many of us are now focused on finding ways to address it,” said Alexander. 

The Senate bill seeks to improve coordination of mental health programs by granting new powers to an assistant secretary in the Department of Health and Human Services and sets up a new office to encourage the adoption of evidence-based programs. The legislation also authorizes grants for topics like integrating physical and mental health services, though the amount of the funding will depend on the appropriations process. It also seeks to push insurance companies to provide better mental health coverage through what is known as “parity.”

Some advocates have criticized the bill for being far too narrow, particularly in the area of helping people with serious mental illnesses. 

Broader provisions are expected to be added to the bill on the floor, however. An area of particular focus is removing a restriction on Medicaid paying for care at certain mental health facilities, known as the “IMD [Institutions for Mental Diseases] exclusion,” which is seen as a major barrier to care access. 

Sens. Susan Collins (R-Maine) and Chris Murphy (D-Conn.) both stressed the provision on Wednesday.

“There are Republicans who support that,” Alexander told reporters. “You heard Sen. Collins comment on it, so I think there’s bipartisan support for it.”

He said the provision could be offered as an amendment on the floor.

Murphy said he has already begun talks with the Senate Finance Committee to find a way to pay for the change. The Congressional Budget Office (CBO) has scored the change at $40 billion to $60 billion over 10 years, a daunting sum. But Murphy said CBO is revisiting that score after being given new information by House lawmakers. 

Other costly provisions could be added later on the Senate floor. Sen. Sheldon Whitehouse (D-R.I.), for example, is looking to fund a $250 million pilot program for mental health providers to be eligible for “meaningful use” financial incentive payments for adopting electronic health records. 

Sen. Roy Blunt (R-Mo.) is also looking to expand a program setting up urgent care mental health clinics from eight states to 24 states. 

Legislation from Sen. John Cornyn (R-Texas), which has been controversial because of its gun provisions, could also be offered as an amendment, Alexander said, adding that Cornyn could also decide to offer his bill separately at a different time. “That’ll be up to him,” Alexander said. 

Some advocates for people with serious mental illnesses have been disappointed that the Senate bill leaves out some provisions that are in a House bill from Rep. Tim Murphy (R-Pa.).

Namely, the Senate bill does not go as far in changing a health privacy law to allow information to be shared with caregivers, and does not provide financial incentives for states to adopt assisted outpatient treatment laws that cover instances in which a judge can order a mentally ill person to follow a treatment plan. 

The House bill became mired in committee amid disputes over those controversial provisions. 

Senators said they hope their work pushes the House along and that Sens. Murphy and Bill Cassidy (R-La.), two of the leaders of the upper chamber’s effort, can serve as an example of bridging partisan differences. 

“I think [the Senate bill] does diverge [with the House bill], but Sen. Murphy and Sen. Cassidy started out with much of the House bill, and they worked with their colleagues to come up with a bipartisan approach that’s a consensus,” Alexander said. “That might help the House come to a conclusion.”